Section A - Current Holder of the waste - Transferor / Transfer

By signing in Section D below I confirm that I have fulfilled my duty to apply the waste hierarchy as required by Regulation 12 of the Waste (England and Wales) Regulations 2011
A1 - Full name
A2 - Are you:
The producer of the waste? 
The importer of the waste? 
The local authority? 
The holder of an environmental permit? 
Registered waste exemption? 

Section B - Person collecting the waste - Transferee

B1 - Full name
B2 - Are you:
The local authority? 
B3 - Are you:
Registered waste exemption? 
A registered waste carrier, broker or dealer? 
Details (are you a carrier, broker or dealer?)
T11 Exemption & ATF

Section C - Data

C1 - Data Collection and Data control:
HDD
USB Flash Pens
SD and Flash Memory
Onsite removal? 
3 Pass Wipe? 
Shred? 

Section D - Description of waste/donation

D1 Description of the waste/donation being transferred including weight and EWC codes:
Are the following items Donated? 
Are the following items electrical waste? 
ITEM WASTE TYPE INC EWC QUANTITY WEIGHT (KG)
TAG SERIAL NUMBER HDD SERIAL NUMBER
Client signature
WeeeCharity signature